Abstract

Background Urolithiasis is the third most common disease of the urinary tract after urinary tract infections and pathologic conditions of prostate. Debate is ongoing regarding the effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) and ureterorenoscopic lithotripsy (URSL) in the management of ureteral stones. Objective We aim to compare the efficacy of Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy in the management of upper ureteric stones in terms of stone clearance. Method This prospective hospital based study included patients with upper ureteric calculus managed with Ureterorenoscopic Lithortripsy with Double J stenting or Extracorporeal Shock Wave Lithotripsy at Dhulikhel Hospital, Kathmandu University Hospital from August 2014 to July 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded. Result There were 90 patients with upper ureteric calculus. Among these patients, 45 patients underwent Extracorporeal Shock Wave Lithotripsy and 45 patients underwent Ureterorenoscopic Lithotripsy. There was no difference in male/female ratio, age and stone diameter between two groups (p>0.05). Total stone-free ratio was 88.9% (40/45) for Extracorporeal Shock Wave Lithotripsy and 82.2% (37/45) for URSL, partial fragmentation requiring shift of modality of treatment was 8.88% (4/45) for Extracorporeal Shock Wave Lithotripsy and 13.33% (6/45) for Ureterorenoscopic Lithotripsy. Failure of procedure was noted in 11.1% in Extracorporeal Shock Wave Lithotripsy group and 17.8% in URSL group In the Extracorporeal Shock Wave Lithotripsy group, 8.89% (4 out of 45) patients required Ureterorenoscopic Lithotripsy for complete stone clearance. Complete stone clearance could not be achieved in 2.23% (1 out of 45) patient with both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy and had to undergo open ureterolithotomy. Conclusion Both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy are equally effective in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio.

Kathmandu Univ Med J (KUMJ). 2017 Oct.-Dec.;15(60):343-346.

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Comments
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In this randomized comparison between SWL and URSL good results were recorded with both methods. Stone clearance with SWL of close o 90% was even better than stone clearance of 82% after URSL. Three and two sessions, respectively, were allowed. The mean number of sessions 2.16 and 1.07 are in accordance with the best reported results.

Conclusions on the value of SWL or URS are almost always discussed in view of the treatment results; stone-free rates with or without CIRFs. Thereby the winning concept will be the method that renders most patients stone-free. Little attention is paid to advantages or disadvantages of the selected methods for stone removal. This way of presenting treatment results might be particularly problematic when, as in this report, the outcome (stone-free rates) of treatment with SWL and URS was almost the same: 89% and 92%, respectively.

An alternative way of visualizing the result and efforts is suggested in the diagram shown below. With this approach the advantage of a non-invasive, anaesthesia-free outpatient procedure is emphasized. Details regarding auxiliary procedures and need of operating theatre as well as some other data were not consistently reported and in such cases the analysis shown below might be useful instead of stone treatment index (STI).

In this figure an advantage is indicated with + 1 and the proportion of stone-free (+ value) compared with negative proportion of repeated sessions and proportion of patients with residuals.

In this randomized comparison between SWL and URSL good results were recorded with both methods. Stone clearance with SWL of close o 90% was even better than stone clearance of 82% after URSL. Three and two sessions, respectively, were allowed. The mean number of sessions 2.16 and 1.07 are in accordance with the best reported results.
Conclusions on the value of SWL or URS are almost always discussed in view of the treatment results; stone-free rates with or without CIRFs. Thereby the winning concept will be the method that renders most patients stone-free. Little attention is paid to advantages or disadvantages of the selected methods for stone removal. This way of presenting treatment results might be particularly problematic when, as in this report, the outcome (stone-free rates) of treatment with SWL and URS was almost the same: 89% and 92%, respectively.
An alternative way of visualizing the result and efforts is suggested in the diagram shown below. With this approach the advantage of a non-invasive, anaesthesia-free outpatient procedure is emphasized. Details regarding auxiliary procedures and need of operating theatre as well as some other data were not consistently reported and in such cases the analysis shown below might be useful instead of stone treatment index (STI).
In this figure an advantage is indicated with + 1 and the proportion of stone-free (+ value) compared with negative proportion of repeated sessions and proportion of patients with residuals.
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